Claims Investigation and Fact Gathering
From first notice to a defensible file
Investigation starts at first notice of loss. Verify the policy was in force on the date of loss, confirm insured or additional-insured status, and capture the basics: what happened, exactly when, where, who was involved, who saw it, and what has been done since. If coverage is uncertain, send a written reservation of rights rather than a denial or a promise. Then gather evidence methodically: recorded or written statements, scene inspection with photographs and measurements, diagrams, witness accounts, police and fire reports, medical records obtained under a valid authorization, prior claim history, public records, and expert opinions on cause and origin. Preserve evidence and maintain chain of custody; the claim file is discoverable and will be read by people who were not there.
Interview discipline
Ask open questions, let the person talk, and record exact words and times. Never suggest answers, never quote coverage or promise payment, and stop immediately if the claimant is represented by counsel. Avoid contacting represented parties directly or discussing the claim with people who have no need to know.
Traps: leading questions that contaminate a statement; skipping the date-of-loss check against the policy period; ignoring evidence that hurts your theory; letting a coverage question stall fact gathering; and treating a claimant's exaggeration as proof of fraud instead of documenting it.
Rule of thumb: cover who, what, when, where, how, and how much, and write the note the same day. Example: a reported pipe-burst water loss where the plumber's invoice shows a leak repair two weeks before the reported date of loss - that discrepancy changes the timeline analysis, so obtain the plumber's records and re-interview before deciding anything.